THE EARLY DIAGNOSIS AND NATURAL HISTORY OF CHRONIC LYMPHATIC LEUKEMIA

Abstract

Nine cases of chronic lymphatic leukemia seen at an early stage of the disease are described. Three of these patients died shortly after the diagnosis of chronic lymphatic leukemia was established from causes unrelated to the leukemia, and autopsies were performed on 2 of these. The lymph nodes in both cases showed no histo-logic changes suggestive of leukemia, although well marked lymphocytic infiltration of the portal tracts of the livers and extensive lymphocytic infiltration of the bone marrows were present. In 1 of these 2 cases the spleen was not enlarged and showed no abnormal histologic changes apart from congestion. Lymph node biopsy was performed at a relatively early stage of the disease in 3 of the remaining cases; the nodes in these cases showed no leukemic changes, while a splenic biopsy performed in 1 of these also showed no leukemic changes. It is concluded that lymph node biopsy is of no value in the diagnosis of early lymphatic leukemia. The leukocyte counts were below 45,000/ cu mm in all but 1 of these cases and from these and other early cases described in the literature it appears that the leukocyte count usually remains low for several years, and that anemia and thrombocytopenia are late manifestations of chronic lymphatic leukemia. It is postulated that there are no signs or symptoms in the 1st stages of chronic lymphatic leukemia, and that this "silent" phase of the disease lasts many years. It is suceeded by a phase, also of many years'' duration in which there are signs of the disease but no symptoms. The classic picture of the disease, with anemia, gross splenomegaly, lymphadenopathy, thrombocytopenia and a very high white cell count, is considered to be only the terminal phase of a disease which usually runs a course lasting from 10 to 20 years.